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Artillery Row

An end to antibiotics?

We risk a return to Victorian times — or worse

Much as we seem to lap up any dystopian scenario which allows us to wallow in existential doom, it seems there is actually a limit to our appetite. We can cope with one overarching forecast of the collapse of life as we know it — the scare of climate change — but once we sign up to that then we have little head space in which to deal with anything else. Even if that threat is more pressing, more immediate and possibly more, well, threatening.

That might explain why there is so little coverage of Antimicrobial Resistance (AMR), the greatest threat to human health since Sir Alexander Fleming discovered penicillin in 1928.

Such dramatic claims tend to lead to yawns — especially in the post-Covid world, where those of us who were not killed by it have tended to downplay the threat it actually posed. And we all remember how the Millennium Bug was going to end civilisation as we knew it at midnight on 31st December 1999.

But resistance to antibiotics is real, is happening now, and is getting worse. 

If they lose their efficacy, we are back to Victorian conditions

Almost all of the medical procedures we now take for granted — such as basic surgery — depend for their safety on antibiotics protecting us from infection. If they lose their efficacy, we are back to Victorian conditions — at best. When the bacteria responsible for the adaptation and evolution of infections is able to withstand drugs that we use to kill them, it is game over.

That is increasingly what is happening, with the process accelerated by the overuse and misuse of antimicrobial drugs, such as antibiotics and antifungals in humans and animals — especially in agriculture. In some countries the vast majority of cattle are fed with antibiotics. Eat a rare steak containing resistant bacteria and you will infect yourself with it.

As Lord Darzi, who has devoted himself to the crisis, puts it: “Bacteria have been around for three billion years, well before humanity existed. They’ve survived all sorts of conditions, from the frozen world to great heat. They survived by mutating; antibiotics are an external threat to bacteria, so they evolve constantly to become resistant to them.”

AMR is already responsible for 1.2 million deaths a year worldwide. There are, for example, patients whose tuberculosis infections are now resistant to everything. Basic infections which used to mean curtains before the use of antibiotics are once again becoming deadly. Conservative estimates predict up to 10 million deaths annually by 2050, with common infections and routine surgical procedures life threatening. 

The fundamental problem is supply. As existing antibiotics lose their power over bacteria, the obvious response is to introduce new ones. But not one new antibiotic for “Gram-negative” bacteria (the most important in this context) has been approved for over 50 years. Initially there was not seen to be any need for new antibiotics. There were enough to do the job already, so why spend a fortune on R&D to duplicate something working well. But once there was a realisation that AMR was becoming an issue, another problem became salient: there is no incentive for pharmaceutical companies to invest in research in this area because returns are, by definition, limited. The entire point of attempts to deal with AMR is to make sure antibiotics are now used far less. With patents lasting 20 years, the economics simply don’t add up for pharma companies.

To which the obvious response is either to increase the length of patents or find another way to incentivise research. The former is logically an option, but impossible in the real world — not least because it would require the renegotiation of international intellectual property treaties. You just can’t go there.

Which leaves some form of governmental incentivisation. The good news is that there has been near unanimity that this is the right way to go since Lord O’Neill was asked by David Cameron to look at the issue in 2014. More recently, Lord Darzi has been working to establish the Fleming Centre to open in 2028. As its site puts it, the centre will “bring science, policy, enterprise and public involvement together to scope, test and scale solutions that are ready for implementation.”

There are positive signs. On Wednesday it was reported that a new class of antibiotics has been discovered. Zosurabalpin seems to destroy one of the three main types of drug-resistant bacteria, Carbapenem-resistant Acinetobacter baumannii (Crab) and is now in human trials. Scientists believe they can build on this to develop further new drugs.

On the same day, the Science, Innovation and Technology committee released its recommendations following a year-long inquiry into the potential of bacteria-killing viruses — called bacteriophages — that could provide an alternative to antibiotics for resistant infections. 

But it’s difficult to feel too positive, given the scale and scope of the crisis. There is, at least, a commitment from some governments. The UK has set up the Global AMR Innovation Fund (GAMRIF) and committed £39 million to it last March. It sounds good, and it’s well meaning. But it’s peanuts. There are all sorts of global “initiatives”, as is the way with these things, and if you look at the government’s website it’s full of action plans and details of meetings in Geneva. But when did you last hear or read about AMR in a newspaper or on TV — let alone from a prime minister or president? It’s marked down as one of those “Important” issues to which slightly more than lip service is paid. But this is, really, about life and death — about life as we now know it and death as we haven’t known it for a century. And that requires more than lip service.

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